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Study Highlights Challenges for Buprenorphine Prescribers
Clinicians waivered under education-exempted US Department of Health and Human Services (HHS) buprenorphine practice guidelines were found to be less likely than traditionally waivered clinicians to prescribe buprenorphine and more likely to practice in emergency/urgent care settings, according to a study published recently in JAMA Health Forum.
The study, produced by researchers from 6 federal health offices, was based on a survey of 2736 clinicians who had a 30-patient limit at the time of survey administration and identified their Drug Addiction Treatment Act (DATA) waiver approval pathway. The survey was conducted online in February 2022. About half (1365 clinicians) received their waiver prior to the education-exempted practice guidelines were released in April 2021. Among those who received their waiver after the guidelines were released, 550 met education requirements and 821 received their waiver under the education-exempted guidelines. Of those, 500 said the traditional waiver education requirements were a reason they previously did not obtain a waiver.
Across all groups, a large majority of clinicians had not prescribed buprenorphine since obtaining a waiver, including the following:
- 35.7% of those who obtained a waiver prior to the guidelines being enacted;
- 41.2% of those who met education requirements but obtained a waiver after the education-exempted guidelines were enacted; and
- 44.3% of those who obtained a waiver through the guidelines.
Clinicians who did prescribe buprenorphine within the prior 6 months said they were treating fewer patients on average, and clinicians across all waiver types said they faced multiple barriers to prescribing. Reasons for not prescribing the opioid use disorder medication varied. The following reasons were cited by clinicians who responded to the survey:
- Lack of patient demand was cited across all groups;
- Prior waiver clinicians more frequently cited lack of patient access to psychosocial services or other behavioral health practitioners, lack of access to addiction specialists for consultation, and lack of access to psychiatric services for patients with co-occurring mental health disorders compared to the education-exempt group;
- Still setting up a practice was a challenge more frequently cited by concurrent waiver clinicians than prior waiver clinicians, while the latter group was more likely to cite an inability to find a supervising physician.
“Our findings suggest that the composition of clinicians opting into buprenorphine-based treatment may change as the regulatory requirements for prescribing buprenorphine evolve,” the researchers wrote. “For example, practice guidelines clinicians were more likely to be physicians, practice in ED or urgent care settings, and practice in urban areas.
“As the regulatory paradigm for buprenorphine prescribing evolves with the elimination of the DATA waiver, it will be important to track the types of clinicians prescribing buprenorphine, identify untapped pools of clinicians not engaging in prescribing, and tailor training and technical assistance accordingly.”
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